New tool launches to improve the benefits claim appeals process at the VA

Today, we are celebrating the nationwide launch of Caseflow Certification, the first of many tools that will begin to improve the processing of benefit claim appeals at the Department of Veterans Affairs (VA).

Last summer, the Board of Veterans’ Appeals (Board) reached out to the Digital Service at VA to assess the disability claim appeals process. We found a familiar sight to anyone who has worked in government — a burdensome medley of antiquated technology, manual processes, and overbearing laws and policies.

This is a story about how the Digital Service is partnering with the incredibly dedicated team at the Board to replace this legacy system at the VA. It’s a story of policy, technology, and human-centered design.

“The appeals process we currently have set in law is failing Veterans — and taxpayers.” — Robert McDonald, Secretary of the VA

Imagine Lawrence — a Vietnam Veteran in his sixties. Lawrence filed a claim seven years ago to increase his disability compensation from the VA after his back injury got so bad that he couldn’t work. Seven years later, he’s still waiting for a final decision. Or think about Lisa, whose husband passed away due to cancer caused by asbestos exposure in the Navy. She appealed to increase his disability compensation package after his death. It’s been three years and she’s still waiting for a final decision too.

Tens of thousands of Veterans are waiting longer than five years for a final appeals decision as the VA continues to face rapid growth in its appeals workload. Between 2012 and 2015, the number of pending appeals climbed by 35 percent to more than 450,000 pending appeals across the VA today. Without significant reform to the current appeals process, this number is projected to soar to more than 2.2 million by the end of 2027.

There are hundreds of thousands of individuals suffering from ailments like post-traumatic stress, exposure to Agent Orange, and tinnitus (ringing in the ears) incurred during their time in service. Veterans and their families are dependent on financial assistance from the benefits claims process to stay healthy and prevent their health issues from worsening.

Robert McDonald, Secretary of the VA, recently acknowledged in a public memo that the appeals process is failing Veterans. Since releasing this memo, the VA has partnered with Congress, state and local government officials, Veterans Service Organizations, and other stakeholders to modernize the current appeals process by making it more timely, fair, modern, and streamlined.

So, we partnered with the Board to redesign the system used to track and process benefit claim appeals. Here’s how.

A human-centered approach (that is, designing for people by first understanding what they need) ensures that we build and design things that actually make sense within the context of someone’s real life. We’ve spent months working closely with the Board and collaborators all across the VA to understand where the Digital Service can have the most impact.

The complex process to review appeals is distributed across many silos at the VA, as required by law. This legal process has only grown more opaque, complex, and harder to understand throughout the years. Laws — established to protect or help Veterans — sometimes end up causing delays.

Steps in the appeals process today. Imagine how hard it is for a Veteran to understand this.

Imagine a Veteran who has waited years for her appeal to be reviewed — she starts to second-guess the system. As her condition worsens, she wants to be heard. She starts sending the VA evidence — doctor’s notes, medical exams, and personal pleas. Little does she know that each time she submits new evidence, her appeal must be reviewed and decided again. She is unwittingly delaying her appeal with each new submission.

Meanwhile, the software used to track appeals both at the Board and throughout the VA was built in the 1980s, with the maintenance left largely to a single developer. Over the last several decades, the appeals tracking software was expanded to support more complex workflows and only recently, the addition of paperless appeals.

The current tool used to track and process appeals. Note: The file information in this image is fake.

We spoke with VA employees across the country to understand their workflows. We sat in their cubicles and looked over their shoulders to figure out what the pain points were in the existing process. Government employees are users too, and they deserve products that meet their needs — products that are helpful, usable, and simple.

A wall in our office used to track the process and pain points, as we observed from VA employees.

Today the Digital Service launches the first of many tools that will begin to improve paperless appeals processing at the VA: Caseflow Certification

Caseflow Certification is a simple web-app that automatically detects if required documentation has been added to an appeal before it moves forward in the process. This simple check will help reduce preventable errors and avoidable delays caused by disjointed, manual processing.

Caserflow Certification, the first of many Caseflow apps.

We designed Caseflow Certification using the U.S. Web Design Standards to ensure the website is accessible and consistent with other government websites. Once we had a working prototype, we went back to the VA Regional Offices to test our assumptions — to keep ourselves honest, and to find out what we needed to improve.

Conducting usability research at the New York Regional Office with longtime Veterans Appeals Decision Review Officer Elizabeth (who has since retired).

In the last six months, we have surrounded ourselves with the support necessary to change the way the agency approaches technology, process, and policy. We recognize that significant legislative and additional process reforms are needed to truly modernize and provide Veterans and their families the service they deserve. Through the delivery of this small project, we’ve established a strong foothold for the future improvement of dozens more workflows at the Board and beyond.

To the outside world, it may be hard to grasp the importance of these simple fixes. Today there are more than 450,000 Veterans that have appeals pending. Each one of these appeals undergoes a protracted cycle of review, delay, and miscommunication. 80,000 Veterans have appeals older than 5 years. 5,000 Veterans have appeals older than 10 years.

But these are just numbers. Behind each of these appeals is a Veteran — a Lawrence or a Lisa. The invisible hand of integrated technology, corresponding process enhancements, and legislative changes that reduce manual processing has the ability to improve Lawrence’s and Lisa’s lives, and make good on our promise to America’s Veterans.